A perennial issue is how to trigger behaviours that are likely to result in good outcomes for the individual. Smoking cessation, regular exercise, more fruit and vegetables, less alcohol….the list is long. There is no magic bullet. Again I make reference to BJ Fogg who offers the most easily digestible way to ponder the question. He promotes the philosophy that innovation is about making it easier for people to do what they already want to do and then triggering that behaviour until it becomes a habit. There are four scenarios:
High motivation and easy to do
An individual in pain will need very little to trigger the relevant behaviour- i.e. take the pill that is stocked in the cupboard. It might be enough to suggest:
Why don’t you take something for that headache?
There are many such scenarios ranging from the life threatening to the debilitating. The symptoms may be enough to trigger the behaviour and act as a ‘signal’ for the patient. Unfortunately many chronic and even life limiting conditions are asymptomatic until complications ensue and the patient may not be motivated simply by knowing they have diabetes or similar with potentially serious complications. The motivation may also wane in time- as happens in the case of many acute infections where as the symptoms abate the motivation to persist with antibiotics drops. The longer the duration of the treatment the less likely that the patient will complete the course. In the case of life long treatments for asymptomatic conditions the probability is low. On the other hand when a patient has perceived that they can do the needful, for example when someone has sourced advice on how to stop smoking, and is motivated to do so, then a simple ‘trigger’ is enough in many cases. Here is some empirical evidence. Health practitioners can provide such triggers- the results will depend on the extent to which motivation and ability are also aligned. Pharmacists may be able to trigger a medical consultation simply by advising it. Perhaps this is the most fruitful avenue for innovation at a time when people are becoming more enabled to self care.
High motivation but hard to do
Many people find it hard to give up bad habits. The mother whose child has suffered another asthma attack is motivated to stop smoking but may perceive it as difficult to achieve. The man who has gained weight in the last decade may feel that more effort is required than he is able to commit to dieting and exercise. The teenager who has recently been in hospital may be advised to inject insulin and give up chocolate may soon quit the regimen. Unfortunately much effort is expended on developing programs to ‘enable’ patients to do ‘hard’ things in this context. It is critical that what needs to be done is made easier or perceived as easier. A ‘facilitator’ trigger in this case would give access to something that is ‘affordable’ in terms of time and effort. Sadly this is also the stomping ground of charlatans who might trigger ‘quick cure’ schemes, things that promise more than they can possibly deliver to vulnerable (highly motivated and paying) individuals. Effective innovation comes from developing better, cheaper treatment regimens and then triggering them as in scenario one above. Often what is developed is not perceived as easier and the innovation fails.
Low motivation and easy to do
In this situation the patient is not motivated to do something from which they might benefit and is easily available. The influenza vaccine is offered at the requisite time each year. Uptake remains a cause for concern. The reasons for poor motivation need careful consideration- they may not be rational and the ‘spark’ trigger- something that will increase motivation to the point where action may be problematic or need a local solution. The challenge is always that motivation is hard to influence- people’s entrenched beliefs are difficult to shift. If the public believes there is a link between a vaccine and a serious illness, it will be challenging to trigger parents to bring their child for vaccination. Much effort is expended on ‘educating’ people who attend health practitioners. Motivation may increase to the point where it can be triggered but the amount of the effort expended by practitioners is governed by Fogg’s formula B=MAT. Practitioners may not behave consistently or effectively for a host of reasons and as has been shown through research this strategy has disappointing results.
Low motivation and hard to do
In many circumstances those who stand to gain the most are the least likely to act on health care advice. People in deprived communities often have fewer choices and have more to contend with then health practitioners are able to address. In these circumstances changing the environment in which people live may have more of an impact then attempting to trigger behaviours that are difficult if not impossible to attain by people with competing priorities. At an individual level a person may get to a point in their life where they are sufficiently motivated and can see a way to achieve a target behaviour. Until then they are unlikely to be triggered
Picture by Hamed Parham